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I <br />PGRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettw3.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS 1 '7 11 i],� <br />I1F� <br />PARCEL TAX I.D. III <br />PERMIT N <br />_ / kl,- 632a S7 Fw" <br />r�oss��ooiooS"oo <br />C. tl g - `/] <br />LEGA LOT NO. <br />DESC. ,3 <br />BLOCK <br />TRACT Q <br />S /P /Zoe <br />OWNER ADDRESS CITYIZIP PHONE <br />n <br />/� �aak �JaZ z�,6��/7•��? <br />c v D6Er�-,.1.SrR<x'saGa/�c. il..vacc-.�9 t <br />TENANT NAfAE <br />CONTACT FOR PERMIT PHONE <br />or-1%- �w�3 <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />�•- <br />CONTR.'17tlftVtE I' I' -• ' <br />031E OP BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />_Electric ( Gas _Other <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />-� <br />A/C - air handling units <br />Forced air systems ' <br />-(p <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />-� <br />Water heater <br />2 <br />Kitchen sink 8 disposal <br />Dishwasher <br />Gas fireplace <br />Gas range <br />2- <br />Clothes washer <br />Z <br />Clothes dryer <br />_ <br />Laundry tray <br />Range hood <br />Sink (service/bar/mop/etc.) <br />t <br />Exhaust (an <br />1 _ <br />Back9ow prevenler <br />Heat pump <br />_ <br />Urinal <br />Unit healer <br />Drinking Fountain I <br />Boller <br />_ <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other <br />_ <br />Other <br />_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other stale or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Slate ContOke5rs Law 18.27 RCW and 296.200 WAC. <br />.. �iGe6�� zS—o <br />Signature of Owner/Contractor/Autho-Fze-FKgon—I Date <br />I/ Z <br />